Abstract
Sunitinib malate is a multi-targeted tyrosine kinase inhibitor used extensively for treatment of human tumors. However, cardiovascular adverse effects of sunitinib limit its clinical use. It is pivotal to elucidate molecular targets that mediate sunitinib-induced cardiotoxicity. Sirtuin 3 (Sirt3) is an effective mitochondrial deacetylase that has been reported to regulate sensitivity of different types of cells to chemotherapies, but roles of Sirt3 in sunitinib-induced cardiotoxicity have not been investigated. In the present study, we established wild type, Sirt3-knockout, and Sirt3-overexpressing mouse models of sunitinib (40 mg kg−1 day−1 for 28 days)-induced cardiotoxicity and examined cardiovascular functions and pathological changes. We further cultured wild type, Sirt3-knockout, and Sirt3-overexpressing primary mouse cardiac pericytes and analyzed sunitinib (10 μMol for 48 h)-induced alterations in cellular viability, cell death processes, and molecular pathways. Our results show that sunitinib predominantly induced hypertension, left ventricular systolic dysfunction, and cardiac pericyte death accompanied with upregulation of Sirt3 in cardiac pericytes, and these cardiotoxicities were significantly attenuated in Sirt3-knockout mice, but aggravated in Sirt3-overexpressing mice. Mechanistically, sunitinib induced cardiac pericyte death through inhibition of GSTP1/JNK/autophagy pathway and Sirt3 interacted with and inhibited GSTP1, further inhibiting the pathway and aggravating sunitinib-induced pericyte death. Conclusively, we demonstrate that Sirt3 promotes sensitivity to sunitinib-induced cardiotoxicity via GSTP1/JNK/autophagy pathway. Our results suggest Sirt3 might be a potential target for developing cardioprotective therapies for sunitinib-receiving patients.
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References
Abdel-Aziz AK, Mantawy EM, Said RS, Helwa R (2016) The tyrosine kinase inhibitor, sunitinib malate, induces cognitive impairment in vivo via dysregulating VEGFR signaling, apoptotic and autophagic machineries. Exp Neurol 283(Pt A):129–141. https://doi.org/10.1016/j.expneurol.2016.06.004
Armulik A, Genove G, Mae M et al (2010) Pericytes regulate the blood-brain barrier. Nature 468(7323):557–561. https://doi.org/10.1038/nature09522
Avolio E, Rodriguez-Arabaolaza I, Spencer HL et al (2015) Expansion and characterization of neonatal cardiac pericytes provides a novel cellular option for tissue engineering in congenital heart disease. J Am Heart Assoc 4(6):e002043. https://doi.org/10.1161/jaha.115.002043
Barth S, Glick D, Macleod KF (2010) Autophagy: assays and artifacts. J Pathol 221(2):117–124. https://doi.org/10.1002/path.2694
Bello CL, Mulay M, Huang X et al (2009) Electrocardiographic characterization of the QTc interval in patients with advanced solid tumors: pharmacokinetic- pharmacodynamic evaluation of sunitinib. Clin Cancer Res 15(22):7045–7052. https://doi.org/10.1158/1078-0432.ccr-09-1521
Bergsbaken T, Fink SL, Cookson BT (2009) Pyroptosis: host cell death and inflammation. Nat Rev Microbiol 7(2):99–109. https://doi.org/10.1038/nrmicro2070
Chagin AS (2016) Effectors of mTOR-autophagy pathway: targeting cancer, affecting the skeleton. Curr Opin Pharmacol 28:1–7. https://doi.org/10.1016/j.coph.2016.02.004
Chintalgattu V, Rees ML, Culver JC et al (2013) Coronary microvascular pericytes are the cellular target of sunitinib malate-induced cardiotoxicity. Sci Transl Med 5(187):187ra69. https://doi.org/10.1126/scitranslmed.3005066
Chu TF, Rupnick MA, Kerkela R et al (2007) Cardiotoxicity associated with tyrosine kinase inhibitor sunitinib. Lancet 370(9604):2011–2019. https://doi.org/10.1016/s0140-6736(07)61865-0
Cooper SL, Sandhu H, Hussain A, Mee C, Maddock H (2018) Involvement of mitogen activated kinase kinase 7 intracellular signalling pathway in Sunitinib-induced cardiotoxicity. Toxicology 394:72–83. https://doi.org/10.1016/j.tox.2017.12.005
D’Arcy MS (2019) Cell death: a review of the major forms of apoptosis, necrosis and autophagy. Cell Biol Int. https://doi.org/10.1002/cbin.11137
DeVorkin L, Hattersley M, Kim P et al (2017) Autophagy inhibition enhances sunitinib efficacy in clear cell ovarian carcinoma. Mol Cancer Res 15(3):250–258. https://doi.org/10.1158/1541-7786.mcr-16-0132
Di Lorenzo G, Autorino R, Bruni G et al (2009) Cardiovascular toxicity following sunitinib therapy in metastatic renal cell carcinoma: a multicenter analysis. Ann Oncol 20(9):1535–1542. https://doi.org/10.1093/annonc/mdp025
Dyczynski M, Yu Y, Otrocka M et al (2018) Targeting autophagy by small molecule inhibitors of vacuolar protein sorting 34 (Vps34) improves the sensitivity of breast cancer cells to sunitinib. Cancer Lett 435:32–43. https://doi.org/10.1016/j.canlet.2018.07.028
Ewer MS, Suter TM, Lenihan DJ et al (2014) Cardiovascular events among 1090 cancer patients treated with sunitinib, interferon, or placebo: a comprehensive adjudicated database analysis demonstrating clinically meaningful reversibility of cardiac events. Eur J Cancer 50(12):2162–2170. https://doi.org/10.1016/j.ejca.2014.05.013
Force T, Krause DS, Van Etten RA (2007) Molecular mechanisms of cardiotoxicity of tyrosine kinase inhibition. Nat Rev Cancer 7(5):332–344. https://doi.org/10.1038/nrc2106
Fu D, Yu JY, Yang S et al (2016) Survival or death: a dual role for autophagy in stress-induced pericyte loss in diabetic retinopathy. Diabetologia 59(10):2251–2261. https://doi.org/10.1007/s00125-016-4058-5
Hamnvik OP, Choueiri TK, Turchin A et al (2015) Clinical risk factors for the development of hypertension in patients treated with inhibitors of the VEGF signaling pathway. Cancer 121(2):311–319. https://doi.org/10.1002/cncr.28972
Izzedine H, Ederhy S, Goldwasser F et al (2009) Management of hypertension in angiogenesis inhibitor-treated patients. Ann Oncol 20(5):807–815. https://doi.org/10.1093/annonc/mdn713
Jiang Q, Gao Y, Wang C et al (2017) Nitration of TRPM2 as a molecular switch induces autophagy during brain pericyte injury. Antioxid Redox Signal 27(16):1297–1316. https://doi.org/10.1089/ars.2016.6873
Kerkela R, Woulfe KC, Durand JB et al (2009) Sunitinib-induced cardiotoxicity is mediated by off-target inhibition of AMP-activated protein kinase. Clin Transl Sci 2(1):15–25. https://doi.org/10.1111/j.1752-8062.2008.00090.x
Klionsky DJ, Abdelmohsen K, Abe A et al (2016) Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). Autophagy 12(1):1–222
Li S, Dou X, Ning H et al (2017a) Sirtuin 3 acts as a negative regulator of autophagy dictating hepatocyte susceptibility to lipotoxicity. Hepatology (Baltimore, MD) 66(3):936–952. https://doi.org/10.1002/hep.29229
Li Y, Ye Z, Lai W et al (2017b) Activation of sirtuin 3 by silybin attenuates mitochondrial dysfunction in cisplatin-induced acute kidney injury. Front Pharmacol 8:178. https://doi.org/10.3389/fphar.2017.00178
Montaigne D, Hurt C, Neviere R (2012) Mitochondria death/survival signaling pathways in cardiotoxicity induced by anthracyclines and anticancer-targeted therapies. Biochem Res Int 2012:951539. https://doi.org/10.1155/2012/951539
Narayan V, Keefe S, Haas N et al (2017) Prospective evaluation of sunitinib-induced cardiotoxicity in patients with metastatic renal cell carcinoma. Clin Cancer Res 23(14):3601–3609. https://doi.org/10.1158/1078-0432.ccr-16-2869
Ni Z, Wang B, Dai X et al (2014) HCC cells with high levels of Bcl-2 are resistant to ABT-737 via activation of the ROS-JNK-autophagy pathway. Free Radical Biol Med 70:194–203. https://doi.org/10.1016/j.freeradbiomed.2014.02.012
Onyango P, Celic I, McCaffery JM, Boeke JD, Feinberg AP (2002) SIRT3, a human SIR2 homologue, is an NAD-dependent deacetylase localized to mitochondria. Proc Natl Acad Sci USA 99(21):13653–13658. https://doi.org/10.1073/pnas.222538099
Palumbo C, De Luca A, Rosato N, Forgione M, Rotili D, Caccuri AM (2016) c-Jun N-terminal kinase activation by nitrobenzoxadiazoles leads to late-stage autophagy inhibition. J Transl Med 14:37. https://doi.org/10.1186/s12967-016-0796-x
Richards CJ, Je Y, Schutz FA et al (2011) Incidence and risk of congestive heart failure in patients with renal and nonrenal cell carcinoma treated with sunitinib. J Clin Oncol 29(25):3450–3456. https://doi.org/10.1200/jco.2010.34.4309
Shah RR, Morganroth J (2015) Update on cardiovascular safety of tyrosine kinase inhibitors: with a special focus on QT interval, left ventricular dysfunction and overall risk/benefit. Drug Saf 38(8):693–710. https://doi.org/10.1007/s40264-015-0300-1
Speed B, Bu HZ, Pool WF et al (2012) Pharmacokinetics, distribution, and metabolism of [14C]sunitinib in rats, monkeys, and humans. Drug Metab Dispos Biol FateChem 40(3):539–555. https://doi.org/10.1124/dmd.111.042853
Sun W, Liu C, Chen Q, Liu N, Yan Y, Liu B (2018) SIRT3: a new regulator of cardiovascular diseases. Oxid Med Cell Longev 2018:7293861. https://doi.org/10.1155/2018/7293861
Tanno M, Kuno A, Horio Y, Miura T (2012) Emerging beneficial roles of sirtuins in heart failure. Basic Res Cardiol 107(4):273. https://doi.org/10.1007/s00395-012-0273-5
Tao NN, Zhou HZ, Tang H et al (2016) Sirtuin 3 enhanced drug sensitivity of human hepatoma cells through glutathione S-transferase pi 1/JNK signaling pathway. Oncotarget 7(31):50117–50130. https://doi.org/10.18632/oncotarget.10319
Thakur PC, Miller-Ocuin JL, Nguyen K et al (2018) Inhibition of endoplasmic-reticulum-stress-mediated autophagy enhances the effectiveness of chemotherapeutics on pancreatic cancer. J Transl Med 16(1):190. https://doi.org/10.1186/s12967-018-1562-z
Torrens-Mas M, Pons DG, Sastre-Serra J, Oliver J, Roca P (2017) SIRT3 silencing sensitizes breast cancer cells to cytotoxic treatments through an increment in ROS production. J Cell Biochem 118(2):397–406. https://doi.org/10.1002/jcb.25653
Townsend DM, Tew KD (2003) The role of glutathione-S-transferase in anti-cancer drug resistance. Oncogene 22(47):7369–7375
US Food & Drug Administration FDA approves sunitinib malate for adjuvant treatment of renal cell carcinoma. In. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-sunitinib-malate-adjuvant-treatment-renal-cell-carcinoma
Yao J, Ma C, Gao W et al (2016) Fentanyl induces autophagy via activation of the ROS/MAPK pathway and reduces the sensitivity of cisplatin in lung cancer cells. Oncol Rep 36(6):3363–3370. https://doi.org/10.3892/or.2016.5183
Zhai M, Li B, Duan W et al (2017) Melatonin ameliorates myocardial ischemia reperfusion injury through SIRT3-dependent regulation of oxidative stress and apoptosis. J Pineal Res. https://doi.org/10.1111/jpi.12419
Zhang L, Ren X, Cheng Y et al (2013) Identification of Sirtuin 3, a mitochondrial protein deacetylase, as a new contributor to tamoxifen resistance in breast cancer cells. Biochem Pharmacol 86(6):726–733. https://doi.org/10.1016/j.bcp.2013.06.032
Zhang J, Ren L, Yang X et al (2018a) Cytotoxicity of 34 FDA approved small-molecule kinase inhibitors in primary rat and human hepatocytes. Toxicol Lett 291:138–148. https://doi.org/10.1016/j.toxlet.2018.04.010
Zhang M, Deng YN, Zhang JY et al (2018b) SIRT3 protects rotenone-induced injury in SH-SY5Y cells by promoting autophagy through the LKB1-AMPK-mTOR pathway. Aging Dis 9(2):273–286. https://doi.org/10.14336/ad.2017.0517
Zhao Y, Xue T, Yang X et al (2010) Autophagy plays an important role in sunitinib-mediated cell death in H9c2 cardiac muscle cells. Toxicol Appl Pharmacol 248(1):20–27. https://doi.org/10.1016/j.taap.2010.07.007
Zhaolin Z, Guohua L, Shiyuan W, Zuo W (2019) Role of pyroptosis in cardiovascular disease. Cell Prolif 52(2):e12563. https://doi.org/10.1111/cpr.12563
Acknowledgements
Thanks to Dr. Xiao Wu and Na Li (The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China) for technical support in use of digital confocal microscopy core facility. This work was supported by the State Key Program of National Natural Science Foundation of China 81530014; National Key R&D Plan of China 2017YFC1700502; National Natural Science Foundation for Young Scientists of China 81700366; Key R&D project of Shandong Province 2017GSF18137.
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Yang, Y., Li, N., Chen, T. et al. Sirt3 promotes sensitivity to sunitinib-induced cardiotoxicity via inhibition of GTSP1/JNK/autophagy pathway in vivo and in vitro. Arch Toxicol 93, 3249–3260 (2019). https://doi.org/10.1007/s00204-019-02573-9
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DOI: https://doi.org/10.1007/s00204-019-02573-9